HomeMy WebLinkAboutAgreement A-13-560-1 Nurse Family Partnership.pdfCounty of Fresno, Department of Public Health
Nurse Family Partnership
1635964v1 / 16453.0001 1
First Amendment to
Program Services Agreement
FY 2015/2016
Parties
Commission: Children and Families Commission of Fresno County, California
Contractor: County of Fresno, Department of Public Health, 1221 Fulton Mall, 4th
Floor, Fresno, CA 93721
Administrative
Original Contract Number: 2014-0954
Amendment 1 Contract Number: 2014-0954
Recitals
A. Commission and Contractor are parties to that certain Program Services
Agreement (the "Agreement"), dated October 7, 2013, the Term of which is from July 1, 2013 to
June 30, 2015 (the "Original Term").
B. The Parties now desire to amend the Agreement to provide for an
extension of the Term and to modify the Services and Project Budget all as defined in the
Agreement.
C. All capitalized terms used in this First Amendment to Program Services
Agreement (this "First Amendment") shall have the meanings provided for in the Agreement
unless otherwise specified in this First Amendment.
Therefore, in consideration of the above recitals, which are incorporated into this
First Amendment by reference, the Parties agree as follows:
1. Term. This First Amendment is made effective as of July 1, 2015 (the
“Effective Date”). The Term of the Agreement is extended until June 30, 2016, unless
terminated earlier under the Agreement (the “Term”) or as specified in this Amendment to the
contrary.
2. Amendment to Section 2.1. Effective as of July 1, 2015, Exhibit A will be
replaced with the Exhibit A, “Scope of Work (2015-16 Fiscal Year)” attached to this First
Amendment and incorporated herein by this reference. As of July 1, 2015, except as needed to
interpret and enforce Contractor’s responsibilities and obligations under the original Term of the
Agreement, the original Exhibit A attached to the Agreement will have no further force and
effect.
3. Amendment to Section 4.1. Section 4.1 of the Agreement is deleted in its
entirety and replaced with the following:
County of Fresno, Department of Public Health
Nurse Family Partnership
1635964v1 / 16453.0001 2
4.1 Project Budget. Compensation for the Services provided from July 1, 2015 to
June 30, 2016 is based upon actual costs as described in Exhibit B.
Compensation for the Services will in no event exceed the total amount of one
hundred eighty-two thousand, $182,000 (the “Contract Amount”). The Contract
Amount excludes Compensation for Services remaining under the Original Term
of the Agreement. Rather, Compensation for Services provided prior to July 1,
2015 shall be in accordance with the original Agreement and not this
Amendment.
4. Amendment to Section 4.2. The first sentence in Section 4.2 of the
Agreement is deleted in its entirely and replaced with the following (the remainder of Section 4.2
is unaffected):
Commission will reimburse Contractor for all necessary, reasonable, and
justifiable expenses, as determined by Commission, incurred in accordance with
the Project Budget for providing the Services on behalf of Commission in an
amount not to exceed the Contract Amount.
5. Controlling Document; No Other Amendment. In the event of any conflict
between the terms of this First Amendment and the Agreement, the terms of this First
Amendment shall control. Except as amended by this First Amendment, all terms of the
Agreement shall remain in full force and effect, including, without limitation, all monitoring,
evaluation, data collection, contract review, auditing, inspection, and record retention obligations
set forth in Article 9 of the Agreement.
6. Binding Effect. The Agreement, as amended by this First Amendment, is
binding upon, and inures to the benefit of, the respective heirs, executors, administrators,
successors, and assigns of the Parties.
7. Headings and Construction. The subject headings of the sections and
paragraphs of this Amendment are included for purposes of convenience only and do not affect
the construction or interpretation of any of its provisions. All words used in this Amendment
include the plural as well as the singular number, and vice versa; words used in this
Amendment in the present tense include the future as well as the present; and words used in
this Amendment in the masculine gender include the feminine and neuter genders, whenever
the context so requires. No provision of this Amendment will be interpreted for or against a
Party because that Party or its legal representative drafted the provision, and this Amendment
will be construed as if jointly prepared by the Parties.
8. Counterparts. This Amendment may be signed by the Parties in different
counterparts and the signature pages combined to create one document binding on all Parties.
9. Signature Authority. Each Party represents that it has capacity, full
power, and authority to enter into this Amendment and perform under modified terms of the
Agreement, and the person signing this Agreement on behalf of each Party has been properly
authorized and empowered to enter into this Amendment. Contractor must sign the signatory
authorization, attached as Exhibit C and incorporated into this Amendment. Contractor must
complete and forward to Commission a new signatory authorization each time any name, title,
or other information in the existing authorization is no longer current.
///
1635964 v1 / 1 64 53.0001
County of Fresno , Department of Public Hea lth
Nurse Family Partnership
Signatures
APPROVED AS TO LEGAL FORM :
DANIEL C . CEDERBORG , COUNTY
COUNSEL
APPROV ED AS TO ACCOUNTING FORM :
VICKI CROW, C.P.A., AUDITOR-CONTROLLER/
TREASURER-TAX COLLECTOR
REVIEWED AND RECOMMENDE D FOR APPROVAL:
By -"""-L/Jt~L! ~+--+--"-"'--'q....,,..<--1£-
David Pomaville, Director
Dep a rtm e nt of Publi c Health
Fund/Subc lass :
Organiz ation :
Account#:
0001 /1000
56201 7 19
3530
County of Fresno, Department of Public Health
Nurse Family Partnership
1635964v1 / 16453.0001 A-1
EXHIBIT A
Scope of Work (2015-16 Fiscal Year)
County of Fresno, Department of Public Health, Nurse Family Partnership, #2014-0954
0715(1&2) Page 1 of 9
Agency Name: County of Fresno, Department
of Public Health
Project Name: Nurse-Family Partnership
Contract Number: 2014-0954
Project ID Number: 0954-14
GL: 10-8504-00
Agency Address: 1221 Fulton Mall, 4th Floor
Fresno, CA 93721
Start date/End date: 7/1/2015-6/30/2016
Term from/to: 7/1/2015-6/30/2016
Contract amount:
$182,000 FY 15-16: $182,000
Other Project Funding:
$198,561
109 %
BOS District: 3 Agency phone #: 559-600-3330
Mailing address if different than above: N/A Agency fax #: 559-600-7729
Website: www.fcdph.org Focus area: Health Promotion
F5FC Contract Manager: Kristina Hernandez
F5FC Finance Manager: Erlan Zuniga
Program Contact
(Person who runs day to day operations/supervisor/coordinator/manager)
Name: Deborah Kuest Title: Supervising Public Health Nurse
E-mail: dkuest@co.fresno.ca.us Phone #: 559-600-3330
Fax #: 559-600-7729 Prefix: Ms.
Finance Contact
(Person responsible for submitting budgets, financial reports and/or invoices)
Name: Michael Chu Title: Accountant
E-mail: mchu@co.fresno.ca.us Phone #: 559-600-6426
Fax #: 559-600-7692 Prefix: Mr.
Notice Contact
(Person who has legal authority to sign contract)
Name: Dave Pomaville Title: Director
E-mail: dpomaville@co.fresno.ca.us Phone #: 559-600-3200
Fax #: 559-600-7687 Prefix: Mr.
Public Contact
(Person responsible for general public calls requesting program information, how to access services, media, etc.)
Name: Deborah Kuest Title: Supervising Public Health Nurse
E-mail: dkuest@co.fresno.ca.us Phone #: 559-600-3330
Fax #: 559-600-7729 Prefix: Ms.
Program Services Face Sheet & Scope of Work
This document will be completed with First 5 Fresno County (F5FC) staff
and Service Provider during a development meeting.
A. Face Sheet
Program Services Face Sheet & Scope of Work
County of Fresno, Department of Public Health, Nurse Family Partnership, #2014-0954
0715(1&2) Page 2 of 9
Persimmony Contact (s) Program Module – PROGRAM DATA ENTRY
(Person responsible for entering client level and/or aggregate data and funded through this contract)
Name: Christina Moreno Title: Office Assistant III
E-mail: cmoreno@co.fresno.ca.us Phone #: 559-600-3330
Fax #: 559-600-7729 Training: Access and No Training Required
Prefix: Ms.
Persimmony Contact (s) Program Module – PROGRAM DATA ENTRY
(Person responsible for entering client level and/or aggregate data and funded through this contract)
Name: Kim Zepeda Title: Supervisor of Office Assistants II
E-mail: kzepeda@co.fresno.ca.us Phone #: 559-600-3330
Fax #: 559-600-7729 Training: Access and No Training Required
Prefix: Ms.
Persimmony Contact (s) Program Module – PROGRAM DATA ENTRY
(Person responsible for entering client level and/or aggregate data and funded through this contract)
Name: Elphia Paras Title: Office Assistant III
E-mail: EParas@co.fresno.ca.us Phone #: 559-600-3330
Fax #: 559-600-7729 Training: Access and No Training Required
Prefix: Ms.
Persimmony Contact (s) Program Module – PROGRAM DATA ENTRY
(Person responsible for entering client level and/or aggregate data and funded through this contract)
Name: Deborah Kuest Title: Supervising Public Health Nurse
E-mail: dkuest@co.fresno.ca.us Phone #: 559-600-3330
Fax #: 559-600-7729 Training: Access and No Training Required
Prefix: Ms.
Persimmony Contact (s) Program Module – PROGRAM DATA ENTRY
(Person responsible for entering client level and/or aggregate data and funded through this contract)
Name: Bertha Aguilar Title: Office Assistant
E-mail: baguilar@co.fresno.ca.us Phone #: 559-600-3330
Fax #: 559-600-7729 Training: Access and No Training Required
Prefix: Ms.
Persimmony Contact (s) Program Module – PROGRAM DATA ENTRY
(Person responsible for entering client level and/or aggregate data and funded through this contract)
Name: Sophia Rodriguez Title: Office Assistant
E-mail: SXRodriguez@co.fresno.ca.us Phone #: 559-600-3330
Fax #: 559-600-7729 Training: Access and Training Required
Prefix: Ms.
Program Services Face Sheet & Scope of Work
County of Fresno, Department of Public Health, Nurse Family Partnership, #2014-0954
0715(1&2) Page 3 of 9
Persimmony Contact (s) Financial Module – FINANCIAL DATA ENTRY
(Person responsible for entering financial information)
Name: Michael Chu Title: Accountant
E-mail: mchu@co.fresno.ca.us Phone #: 559-600-6426
Fax #: 559-600-7692 Training: Access and No Training Required
Prefix: Mr.
Persimmony Contact (s) Financial Module – FINANCIAL APPROVAL
(Person responsible for approving financial information)
Name: Deborah Kuest Title: Supervising Public Health Nurse
E-mail: dkuest@co.fresno.ca.us Phone #: 559-600-3330
Fax #: 559-600-7729 Training: Access and No Training Required
Prefix: Ms.
Persimmony Contact (s) Financial Module – FINANCIAL APPROVAL
(Person responsible for approving financial information)
Name: Aphivanh (Appy) Xayavath Title: Staff Analyst
E-mail: axayavath@co.fresno.ca.us Phone #: 559-600-3330
Fax #: 559-600-7729 Training: Access and No Training Required
Prefix: Ms.
Persimmony Monitoring Module – ANNUAL CONTRACT REVIEW (ACR) ACCESS
(Person responsible for responding to the financial component of ACR)
Name: Deborah Kuest Title: Supervising Public Health Nurse
E-mail: dkuest@co.fresno.ca.us Phone #: 559-600-3330
Fax #: 559-600-7729 Prefix: Ms.
Persimmony Monitoring Module – ANNUAL CONTRACT REVIEW (ACR) ACCESS
(Person responsible for responding to the financial component of ACR)
Name: Michael Chu Title: Accountant
E-mail: mchu@co.fresno.ca.us Phone #: 559-600-6426
Fax #: 559-600-7692 Prefix: Mr.
Program Services Face Sheet & Scope of Work
County of Fresno, Department of Public Health, Nurse Family Partnership, #2014-0954
0715(1&2) Page 4 of 9
Agency Service Locations:
List all physical addresses where F5FC services take place. If more than three sites, please include in
this document by adding another row. Refer to the Fresno County website to find the correct County
District for each service location.
Project Description:
Briefly address what F5FC is funding and why. If applicable, describe the goals/outcomes.
This will be placed on the F5FC website.
The Nurse-Family Partnership (NFP) program is an evidence-based community healthcare program that
empowers low-income, vulnerable first-time mothers to become confident, knowledgeable, and
responsible parents, and ensures that their babies have the best possible start in life. The program is
voluntary; mothers are enrolled in the program early in pregnancy and receive ongoing nurse home visits
that continue until children reach their second birthday. Nurses establish trusting relationships with
mothers and provide guidance for emotional, social, and physical challenges as expectant mothers
prepare to become parents. NFP nurses support mothers by connecting them to prenatal care and
preventative health practices, providing individualized guidance on specific child developmental stages,
as well as assisting mothers in their maternal life course development. NFP accomplishes the following
goals: improving pregnancy outcomes, child health and development, and economic self -sufficiency of
the family.
Primary Strategy per F5FC Strategic Plan:
Location(s) District(s)
Location 1: 1221 Fulton Mall, Brix Building-4th Floor, Fresno, CA
93721
District 3
F5FC Strategy Percent of
Funding
Dollar Amount
HD4 Evidence-Based Home Visitation Programs 100 $182,000
Program Services Face Sheet & Scope of Work
County of Fresno, Department of Public Health, Nurse Family Partnership, #2014-0954
0715(1&2) Page 5 of 9
State Reporting Result Area & Service Area:
Refer to the Annual Report & School Readiness Appendices Fiscal Year
Is this an evidence based or research based program?
(Please check one)
Evidence Based
Research Based
N/A
Please note that these fields reflect the client type options in Persimmony and not family relationships. Include all
client level and aggregate clients included in sections C and D.
Types of Clients Served and Projected Numbers:
Type of Client Total # of Clients
Child 0<3 37
Child 3-5 0
Parent 37
Prenatal 8
Other 0
TOTAL: 82
Projected Numbers Served in Each Geographic Region:
State Result Area/Outcome State Service Area
Percent of
Clients
(%)
Percent of
Funding
(%)
Improved Child Health Maternal and Child Health Care 55% 85
Improved Child Development Comprehensive Screening and Assessements 45% 10
Improved Child Health Tobacco Education Outreach 30% 5
Geographical Location of Clients to be Served Total # of Clients Percent
Urban (%)
Percent
Rural (%)
Countywide 82 80% 20%
B. Demographic and Geographic Client Served Details
Program Services Face Sheet & Scope of Work
County of Fresno, Department of Public Health, Nurse Family Partnership, #2014-0954
0715(1&2) Page 6 of 9
Service Type F5FC Strategy F5FC Indicators
Core
Client
Type
Core
Client
Target #
(Expected
# of clients
receiving
service)
Frequency
Verification
Method
Parent partnership home visit 1 HD4 Evidence-Based Home Visitation Programs Parents who understand children’s dev. milestones Parent
45
Q1: 40
Q2: 40
Q3: 40
Q4: 40
Frequency varies: please see
endnotes
Service log
ASQ HDX3 Developmental Screenings and Assessments
Children screened, referred, txed for dev. beha Child
37
Q1: 6
Q2: 9
Q3: 10
Q4: 12
Within 150 days of enrollment
and as needed (ASQ is
administered starting at 2
months through 24 months
ASQ/ASQ:SE
ASQ:SE HDX3 Developmental Screenings and Assessments
Children screened, referred, txed for dev. beha
Child
20
Q1: 5
Q2: 5
Q3: 5
Q4; 5
ASQ:SE
is authorized for initial use at 6
months
ASQ/ASQ:SE
Other assessment-
EPDN/PHQ-9 2
P9 PMAD screening and referral
Women who are screened referred for prenatal PD
Parent
20
Q1: 5
Q2: 5
Q3: 5
Q4; 5
Intake, 32-36 weeks, 6-8 weeks
postpartum, 4-6 months, 12
months, (as needed)
Service log
Other assessment-DANCE 3
HD4 Evidence-Based Home Visitation Programs
Parents who understand children’s dev. milestones
Parent
15
Q1: 5
Q2: 3
Q3: 3
Q4; 4
Postpartum, infancy and toddler
Service log
Developmental referral
HCX4 Connecting Families with Resources
Parents who are know about able to access serv.
Child
1
Q1: 0
Q2: 1
Q3: 0
Q4: 0
Annually and as needed
Service log
Other referral 4
HCX4 Connecting Families with Resources
Parents who are know about able to access serv.
Parent
60
Q1: 15
Q2: 15
Q3: 15
Q4: 15
Annually and as needed
Service log
All services listed in section C are required to be entered in Persimmony on a monthly basis, refer to the Service Provider Manual for details.
All clients served by F5FC funds must meet age and residency requirements. Service Provider is required to maintain back-up documentation. The information in the
table below will remain the same for the full contract term (from one fiscal year to the next) unless otherwise specified or modified through a contract amendment request.
C. Outputs: Services and Contacts
Program Services Face Sheet & Scope of Work
County of Fresno, Department of Public Health, Nurse Family Partnership, #2014-0954
0715(1&2) Page 7 of 9
Service Provider Staff Confidentiality Agreement & Request for Persimmony User Logon
All staff members of F5FC funded programs and projects (Service Providers) who are responsible for gathering or
maintaining confidential information and records must adhere to this agreement.
Responsibilities
During the performance of Service Provider assigned duties related to the F5FC project, Service Provider might
have access to confidential client information and records required for effective coordination and delivery of
services to children and their families. All confidential discussions, deliberations, records, and information
generated or maintained in connection with these activities shall be disclosed only to persons who have the need to
know and authority to access confidential consumer information or records. This includes information obtained and
conveyed through all media including the Persimmony database. Service Provider must not disclose any
confidential client information to any third party without the written authorization from the client or legally
authorized representative.
Legal Liabilities
Service Provider must adhere to the following:
• Notice: All applicable employees, agents, and subcontractors shall be notified of state requirements for
confidentiality and also notified that any person knowingly or intentionally violating the provisions of the state
law is guilty of a misdemeanor.
• Records pertaining to any individual recipient of F5FC will be confidential and will not be open to examination
for any purpose not directly connected with the administration of local evaluation.
• No person will publish, disclose, use, or permit the use of, or cause to be published, disclosed or used, any
confidential information pertaining to any individual recipient of F5FC services.
Prohibition of Re-Disclosing Confidential Client Information Employment Confidentiality
Agreement
This notice accompanies a disclosure of confidential information concerning a consumer of services funded by the
F5FC. The above referenced agency is prohibited from making any further disclosure of this confidential
information unless further disclosure is expressly permitted by the written authorization to release the information of
the person to whom it pertains or as otherwise permitted by these regulations. A general authorization for the
release of confidential information is NOT sufficient for this purpose.
Acknowledgement of Confidentiality and Prohibition of Re-Disclosing Confidential Client
Information Employment Confidentiality Agreement
The Agency acknowledges responsibility not to divulge any confidential information or records concerning clients of
F5FC funded services without proper written authorization. By signing the Program Services Agreement, the
Agency accepts confidentiality and prohibition of re-disclosing confidential funding requirements.
Program Services Face Sheet & Scope of Work
County of Fresno, Department of Public Health, Nurse Family Partnership, #2014-0954
0715(1&2) Page 9 of 9
1 Parent Partnership Home Visit: NFP follows a home-visiting schedule to meet the program
goals and integrates self-efficacy, human ecology, and attachment theories within its nursing
framework creating a unique context for learning, growth and overall well-being. Frequency of
home visits will vary as follows: once a week for the first 4 weeks; then every other week until
the baby is born; once a week for 6 weeks after the baby’s birth; every other week until the child
is 21 months; and monthly until 24 months. Once the child turns two years old, the family is
transitioned out of the program.
2 Other assessment EPDS/PHQ-9: Edinburg Postnatal Depression Scale will be administered
at intake and 32-36 weeks antepartum, 4-6 weeks postpartum, 4 months, 12 months and as
needed. In addition, the client count includes, an abuse assessment screening tool (partner
relationship assessment) will be administered at intake and 32-36 weeks antepartum, 4-6 weeks
postpartum, 4 months, 12 months and as needed. The program is in the process of changing
tools and will begin implementing the Patient Health Questionnaire PHQ-9. The total client count
of 20 is a reduced number of clients due to majority of clients in the program who are
postpartum.
3 Other assessment (DANCE): Dyadic Assessment of Naturalistic Caregiver-child
Experiences (DANCE) is a strengths-based assessment tool to aid the nurse in identifying areas
of strengths and areas of growth in their clients. Children who experience positive caregiver-
child interactions will engage more with their caregivers, will reinforce caregivers’ behaviors, and
will develop a sense of trust in their relationships with their caregivers and others. DANCE will
be completed at 2, 9, 16, and 22 months of age. The client count of 15 for this service is a
reduced number of clients based on the need of each client determined by the public health
nurse.
4 Other Referral: Total client count of 60 is a duplicated number, since the families enrolled (45)
will likely receive more than one referral.
County of Fresno, Department of Public Health
Nurse Family Partnership
1635964v1 / 16453.0001 B-1
EXHIBIT B
Project Budget (2015-16 Fiscal Year)
1
2
3
4
5
6
7
8
9
Year 3 Revised Budget
Year 3
10 7/1/15-6/30/16 7/1/15-6/30/16
11
12
13 83,694 0 83,694
14 58,933 0 58,933
15 6,403 0 6,403
16 149,030 0 149,030
17
18 1,092 0 1,092
19 2,386 0 2,386
20 6,784 0 6,784
21 0 0 0
22 10,262 0 10,262
23
24 5,163 0 5,163
25 5,163 0 5,163
26 1,000 0 1,000
27 0 0 0
28 16,545 0 16,545
29
30 182,000 0 182,000
31
32
33 A.Leveraged 198,561
34 B.Other Funding Source:0
35 C.Other Funding Source:0
36 198,561
FIRST 5 FRESNO COUNTY
Category
Agency Name:
Project Name:
Contract Term:
Contract Number:
Direct Service Budget
07/01/15 to 06/30/16
Nurse Family Partnership
County of Fresno Department of Public Health
A. Facilities Costs
B. Operational/Supplies
Total Program
C. Training/Travel
D. Misc. Charges
Total Operating Expenses
III. Program Expenses
A. Materials and Supplies
Total Program Expenses
A. Salaries
B. Benefits
C. Taxes
Total Personnel
II. Operating Expenses
Title:
Prepared by:
Date of Submission:
Revised Budget:
2014-0954
03/20/15
Appy Xayavath
Staff Analyst
Total Program
Amount
Total Other Funding
IV. Professional Services
V. Equipment
VI. Indirect Costs
VII. Other Funding
I. Personnel
No Yes
Children Families Commission of Fresno County
Service Provider Budget
7/30/2015 1 of 1
1 Agency Name:Contract Term:
2 Project Name:Contract Number:3
4
5
6
7 Title FTE Amount Title FTE Amount Title FTE Amount
8 Supervising Public Health Nurse 0.12 12,754 Supervising Public Health Nurse 0.13 13,411 -
9 Public Health Nurse II 0.41 34,596 Public Health Nurse II 0.59 49,047
10 Public Health Nurse I 0.52 36,344 Public Health Nurse I 0.48 33,198
11
12
13
14
15 1.05 83,694 1.20 95,656 - -
16 B. Benefits 70.415%
17 C. Taxes 7.650%
18
19
Justification of Benefits and
Taxes:
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
43
44
45
46
48
49
50 Program Totals
51
52
53 A. Program Total @ %10.00%
54
55 Total Proposed Budget
Narrative/Justification –
182,000 198,561 -
The actual County indirect cost rate is 14.676%, however, indirect costs were calculated at the allowable rate of 10% of program costs.
VI. Indirect (= Program Totals - Equipment x Percentage of Indirect)
Instructional Information In the Narrative/Justification box explain these costs, how they will support/benefit the program, and how the percentage was determined.
16,545 18,051 -
Narrative/Justification – Narrative/Justification – Narrative/Justification –
165,455 180,510 -
Instructional Information In the Narrative/Justification box delineate and explain these costs and how they will support/benefit the program. Also, include the calculations where applicable.
Equipment will be allowed on a case by case basis by the First 5 Contract Manager and Finance Staff. Please give name of employee receiving equipment and cost.
Subtotal - - -
Narrative/Justification –
V. Equipment (Tangible assets that do not exceed $5,000 per unit or aggregation of same units)
Estimated costs for interpreters/translators who provide services for various languages through a Countywide contract.
IV. Professional Services (Contracts, MOU's, Sub agreements, etc.)
Instructional Information In the Narrative/Justification box provide a detailed explanation of all professional services considered on this line item and how they are to support the program or
staff (include calculations where applicable). Any services exceeding $5,000 must have attached a narrative delineating services.
Subtotal 1,000 - -
Narrative/Justification – Provide the number of participants, cost per item, a description of the item, and justification for all expenses that support the clients of the program.
Narrative/Justification for Materials and Supplies
Subtotal 5,163 - -
Books and publications ($730). Forms, pamphlets, developmental/educational materials needed to evaluate and assist NFP clients ($4,433).
III. Program Expenses
Instructional Information In the Narrative/Justification box provide a detailed explanation of all program expenses considered on this line item and how they are to support the program
participants (include calculations where applicable).
A. Materials and Supplies 5,163 - -
Operating Expenses Subtotal 10,262 10,180 -
Narrative/Justification – Explain these costs and how they apply to the program, then state methodology (FTE, Square Footage, etc) for these costs and provide the calculation
D. Misc Charges - - -
Narrative/Justification – Explain these costs and how they apply to the program, then state methodology (name of local conferences & trainings) for these costs and provide the calculation
Local meetings, conferences, and training ($500). Private auto mileage reimbursement at a rate of $0.575 per mile ($2,000). County vehicle
garage/maintenance/usage costs ($11,795), based on estimated Internal Service Fund allocation. ISF estimated allocation adjusted slightly for anticipated use.
First 5 is billed actuals.
C. Training/Travel 6,784 7,511 -
Narrative/Justification – Explain these costs and how they apply to the program, then state methodology (materials, services, leases) for these costs and provide the calculation
General office supplies such as paper, pencils, envelopes, and filing supplies ($2,000), postage ($36), and printing ($50). Rent of storage container for archived
files ($693). Medical supplies such as stethescopes, baby scales, etc. ($1,067) for the nurses to conduct assessments.
B. Operational/Supplies 2,386 1,460 -
Narrative/Justification – Explain these costs and how they apply to the program, then state methodology (FTE, Square Footage, etc) for these costs and provide the calculation
Address: Fresno County Department of Public Health, 1221 Fulton Mall, 4th floor, Fresno, CA 93721. Costs cover the facilities, charges are determined by
square footage allocation to the program. The details are: telephone/communication ($742) and household expenses ($1,559). These are all ISF (internal
service funds) charges. General Services Administration provides the base amount for the department. NFP staff use 1,225 sq ft.
A. Facilities Costs 1,092 1,209 -
II. Operating Expenses
Salaries and benefits reflect rates for FY 2015-16. Estimated benefits rates reflect Unemployment Insurance (.00122), Retirement (.4901-
.6245), OASDI (.0765), Health Insurance ($6945 per FTE per year) and Benefits Administration ($144 per FTE per year).
Personnel Subtotal 149,030 170,330 -
58,933 67,356 -
6,403 7,318 -
I. Personnel
The "Amount" should be: Annual
Salary X the FTE whenever possible
A. Total Salaries & FTE
First 5 Amounts Leveraged Select Other Funding Source:
Fiscal Period 1 (07/01/15-06/30/16)Fiscal Period 1 (07/01/15-06/30/16)
County of Fresno Department of Public Health 07/01/15 to 06/30/16
Nurse Family Partnership 2014-0954
A B C D
Fiscal Period 1 (Insert Date Range)
County of Fresno, Department of Public Health
Nurse Family Partnership
1635964v1 / 16453.0001 C-1
EXHIBIT C
Signature Authorization
County of Fresno, Department of Public Health
Nurse Family Partnership
Children and Families Commission of Fresno County
Exhibit C-Signatory Authorization
1 CERTIFY THAT Deborah A. Poochigian, Chairman, Board of Supervisors
(name & title)
IS AUTHORIZED TO SIGN FOR, AND BY VIRTUE OF HIS/HER SIGNATURE, BIND
County of Fresno
Signature of Governing Body Official &
Date Signed:
Typed Name:
Title: Chairman, Board of Supervisors
Signature of Official Authorized Above & 1 ~ I ___ ~I J {l
Date Signed: fJLt.U'Ttzlh/ .
Typed Name: Deborah A. Poochigian
Title: Chairman, Board of Supervisors
Note: Should circumstances require a change in the above, a new signatory authorization
must be com leted and forwarded to Commission.
1635964v1/16453.0001 C-1
ATTEST:
BERNICE E. SEIDEL, Clerk
Bo~ Supe,rvisors By~.U.X--~tt
puty